Extrapulmonary tuberculosis by nationality, The Netherlands, 1993-2001

This study describes the epidemiology of extrapulmonary tuberculosis (TB) in the Netherlands from 1993 through 2001. We assessed whether the increasing numbers of inhabitants with a non-Western ethnic background had an effect on the number of extrapulmonary patients. We used data from the Netherlands Tuberculosis Register and included all cases of TB diagnosed in the Netherlands between January 1, 1993, and December 31, 2001. Information on age, sex, nationality, year of diagnosis, culture result, anatomic location of the site of disease, and HIV status was retrieved from the register. Of 13,258 patients with TB, 8216 (62%) had pulmonary TB, and 5042 (38%) had extrapulmonary TB. Non-Dutch nationals were more likely to have most types of extrapulmonary TB. The growth of the number of inhabitants with a non-Western ethnic background in the Netherlands explains the proportional growth of extrapulmonary TB. Physicians need to be aware of the changing clinical picture of TB.     

Pertussis--United States, 2001-2003

Pertussis is a highly contagious, vaccine-preventable bacterial illness characterized by paroxysmal cough, posttussive vomiting, and inspiratory whoop. Pertussis also can occur as a mild or moderate cough illness in persons who are partially immune. In the United States, most hospitalizations and nearly all deaths from pertussis are reported in infants aged <6 months, but substantial morbidity does occur in other age groups. Infant/childhood vaccination has contributed to a reduction of more than 90% in pertussis-related morbidity and mortality since the early 1940s in the United States. Estimates of childhood vaccination coverage with > or =3 doses of pertussis-containing vaccine have exceeded 90% since 1994; however, reported pertussis cases increased from a historic low of 1,010 in 1976 to 11,647 cases in 2003. A substantial increase in reported cases has occurred among adolescents, who become susceptible to pertussis approximately 6-10 years after childhood vaccination. Recently, booster vaccines for adolescents and adults combining pertussis antigens with tetanus and diphtheria toxoids (Tdap) were approved by the Food and Drug Administration (FDA). On June 30, 2005, the Advisory Committee on Immunization Practices (ACIP) recommended Tdap for all persons aged 11-18 years. This report summarizes national surveillance data on pertussis reported to CDC during 2001-2003 and focuses on pertussis reported among persons aged 10-19 years before implementation of national recommendations for adolescent pertussis vaccination.     

Surveillance of influenza in Apulia, Italy, 1999-2000, 2000-2001, 2001-2002, and 2002-2003 seasons

BACKGROUND: The objective of this study was to evaluate, within the Italian National Influenza Epidemiological and Virological Surveillance, the rate of vaccination coverage, the incidence of Influenza Like-Illness (ILI), the incidence of Acute Respiratory Illness (ARI), and to identify the virus strains circulating in Apulia from 1999 to 2003. METHODS: Vaccination coverage rates were calculated based on the number of doses administered to individuals > 65 years of age. Every week, sentinel physicians reported ILI and ARI cases having occurred among their patients. Voluntary general practitioners (GPs) and paediatricians (Ps) collected oropharyngeal swab samples from patients suspected with ILI. Influenza viruses were isolated and identified by cell culture (MDCK cells) and RT-PCR. Virological surveillance was carried out by the ISS, in collaboration with a network of peripheral laboratories. RESULTS: In Apulia, vaccination coverage progressively increased to 68.6% during the 2002-2003 season. The analysis of ILI cases showed higher incidence rates during the 1999-2000 and 2002-2003 seasons. ARI rates appeared to have a more constant trend. ILI and ARI incidence rates were higher in the 0-14 year age group. CONCLUSION: The increase in vaccination coverage rates and implementation of the network of clinical, and epidemiological and virological surveillance are fundamental for the control and prevention of influenza.     

Revised birth and fertility rates for the United States, 2000 and 2001.

OBJECTIVES: This report presents revised birth and fertility rates for 2000 and 2001, based on populations consistent with the April 1, 2000, census. Rates are presented by age, race, and Hispanic origin of mother; by age, race, and Hispanic origin of mother for unmarried women; and by age and race of father. To put the rates for 2000 and 2001 into context, rates are also shown for 1990. METHODS: Populations were produced for the Centers for Disease Control and Prevention's National Center for Health Statistics under a collaborative arrangement with the U.S. Census Bureau. The populations reflect the results of the 2000 census. This census allowed people to report more than one race for themselves and their household members, and also separated the category for Asian or Pacific Islander persons into two groups (Asian; Native Hawaiian or Other Pacific Islander). These changes reflected the Office of Management and Budgets 1997 revisions to the standards for the classification of Federal data on race and ethnicity. Because only one race is currently reported in birth certificate data, the 2000 census populations were "bridged" to the single race categories specified in the Office of Management and Budget's 1977 guidelines for race and ethnic statistics in Federal reporting, which are still in use in the collection of vital statistics data. RESULTS: Population-based birth and fertility rates for 2000 and 2001, based on the 2000 census, are somewhat lower for Hispanics (11 percent for the fertility rate in 2001) and Asian or Pacific Islanders (7 percent) and considerably lower for American Indians (18 percent) than the rates previously published based on populations projected from the 1990 census. Rates for most other population subgroups differ little from those previously published. Because of these patterns, the differentials in fertility among population subgroups remain, but are somewhat reduced. Between 1990 and 2001, teenage birth rates declined, rates for women in their twenties changed little, and rates for women in their thirties and forties rose.     

Dengue fever, Hawaii, 2001-2002

Autochthonous dengue infections were last reported in Hawaii in 1944. In September 2001, the Hawaii Department of Health was notified of an unusual febrile illness in a resident with no travel history; dengue fever was confirmed. During the investigation, 1,644 persons with locally acquired denguelike illness were evaluated, and 122 (7%) laboratory-positive dengue infections were identified; dengue virus serotype 1 was isolated from 15 patients. No cases of dengue hemorrhagic fever or shock syndrome were reported. In 3 instances autochthonous infections were linked to a person who reported denguelike illness after travel to French Polynesia. Phylogenetic analyses showed the Hawaiian isolates were closely associated with contemporaneous isolates from Tahiti. Aedes albopictus was present in all communities surveyed on Oahu, Maui, Molokai, and Kauai; no Ae. aegypti were found. This outbreak underscores the importance of maintaining surveillance and control of potential disease vectors even in the absence of an imminent disease threat.     

Human metapneumovirus, Australia, 2001-2004

We examined 10,025 respiratory samples collected for 4 years (2001-2004) and found a 7.1% average annual incidence of human metapneumovirus. The epidemic peak of infection was late winter to spring, and genotyping showed a change in predominant viral genotype in 3 of the 4 years.     

The insurance gap and minority health care, 1997-2001

Gaps in access to medical care among working-age white Americans, African Americans and Latinos failed to improve between 1997 and 2001, despite a booming economy and increased national attention to narrowing and eliminating minority health disparities. African Americans and Latinos continue to have less access to a regular health care provider, see a doctor less often and lag behind whites in seeing specialists, according to recent findings from the Center for Studying Health System Change (HSC). Ethnic and racial disparities in access among uninsured Americans are much greater than disparities among the insured. Uninsured whites' greater financial resources may explain why they have fewer problems accessing care. Eliminating disparities in minority health care will be difficult without first eliminating these gaps in minority health insurance.     

Enterovirus surveillance--United States, 2000-2001

Enteroviruses are common viruses associated with diverse clinical manifestations ranging from mild febrile illness to severe and potentially fatal syndromes including aseptic meningitis, encephalitis, neonatal systemic enteroviral disease, and paralytic poliomyelitis. A total of 64 enterovirus serotypes are recognized, including 61 nonpolio enteroviruses. Individual serotypes have different temporal patterns of circulation and often are associated with different clinical manifestations. This report describes temporal trends in reported enterovirus infections in the United States during 2000-2001, including widespread activity of two serotypes (echoviruses 13 and 18) that previously were detected rarely. Monitoring of circulating enterovirus serotypes helped identify these two agents as the primary causes of aseptic meningitis outbreaks in the United States in 2001. Further improvements in timeliness of reporting and geographic representation of the system are needed to allow more complete surveillance for enteroviruses.